PROBLEM
After being involved in an automobile accident, this 30-year-old man complains of back pain. What is your interpretation of the frontal and lateral views of his lumbar spine?

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ANSWER
The correct diagnosis is a burst fracture, also called Chance fracture, of the L3 vertebra. The compression of L3 is most evident in the lateral view. Less obvious is the linear lucency that can be seen horizontally in the frontal film and extends through the neural arch in the lateral film. This type of fracture is accompanied by retropulsion and neutral compression.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville. Emerg Med 38(7):59-60, 2006